Transforaminal Epidural Steroid Injection Versus Oral Corticosteroids for Acute Lumbar Radiculopathy: A Prospective...

Acute low back pain with radicular symptoms is a common and disabling condition. Corticosteroids are frequently used when conservative management fails; however, the comparative effectiveness of transforaminal epidural steroid injection (TFESI) versus oral corticosteroid therapy remains inadequately defined. This prospective observational comparative study aimed to evaluate and compare short-term pain reduction (Visual Analogue Scale [VAS]), functional improvement (Modified Oswestry Disability Index [MODI]), and neural tension changes (Straight Leg Raise Test [SLRT]) at 12 weeks between TFESI and oral corticosteroid therapy in patients with MRI-confirmed acute lumbar radiculopathy.

This prospective observational study was conducted at a tertiary care center between June 2023 and December 2024. Treatment allocation was non-randomized and determined as part of routine clinical practice. Thirty-four patients aged 18-70 years with MRI-confirmed lumbar disc herniation and persistent radicular pain after at least three weeks of conservative treatment were enrolled. Patients received either a single fluoroscopy-guided TFESI with 40 mg triamcinolone acetonide (n = 17) or a 15-day tapering course of oral prednisolone (total dose 600 mg; n = 17). Outcomes were assessed at baseline and at 1, 3, 6, and 12 weeks using VAS for back and leg pain, MODI, and SLRT.

Baseline demographic, clinical, and radiological characteristics were comparable between groups. The TFESI group demonstrated significantly greater improvement in VAS back pain, VAS leg pain, MODI scores, and SLRT values at 1, 3, and 6 weeks compared with the oral steroid group (p < 0.001). Early median reductions in leg pain (70%) and back pain (60%) and marked functional improvement were observed following TFESI. By 12 weeks, between-group differences diminished and were no longer statistically significant, indicating convergence of outcomes over time.  Conclusion: In this prospective non-randomized cohort, TFESI was associated with faster and more pronounced short-term pain relief and functional improvement than oral corticosteroids in patients with acute lumbar radiculopathy; however, outcomes were comparable by 12 weeks.